Provider Demographics
NPI:1790332815
Name:LIFE BALANCE MEDICAL CENTER
Entity Type:Organization
Organization Name:LIFE BALANCE MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ARN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-623-1013
Mailing Address - Street 1:5069 EDGEMERE CT
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:IL
Mailing Address - Zip Code:61073-8800
Mailing Address - Country:US
Mailing Address - Phone:815-623-1013
Mailing Address - Fax:815-623-1017
Practice Address - Street 1:5069 EDGEMERE CT
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:IL
Practice Address - Zip Code:61073-8800
Practice Address - Country:US
Practice Address - Phone:815-623-1013
Practice Address - Fax:815-623-1017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty